[A case of prolactinoma presenting with CSF rhinorrhea and CSF otorrhea during bromocriptine therapy]

Cerebrospinal fluid (CSF) leakage is a rare complication of prolactinoma treated with bromocriptine (BC). BC is known to be effective for reducing the volume of a prolactinoma and for decreasing the serum level of prolactin (PRL). In cases of pituitary tumors, CSF leakage is thought to be caused by shunting between the subarachnoid and extradural spaces. We had a case presenting with CSF rhinorrhea and CSF otorrhea during BC therapy which was treated successfully. The mechanism and treatment of CSF leakage were studied. A 55-year-old woman complaining of nasal obstruction and headache was admitted to our hospital on Nov. 22, 1988. CT scan showed a huge intracranial mass lesion involving the sella and the supra-sellar region and invading the sphenoid sinus and ethmoid sinus. Serum PRL level was 18,000 ng/ml. The patient was diagnosed as having an invasive prolactinoma, and BC therapy (5.0 mg per day) was instituted. Three days later, CSF rhinorrhea developed, and BC treatment discontinued; radiation therapy was started. After 36 Gy irradiation the size of the tumor was same on CT, and serum level of PRL was still high. The patient underwent trans-sphenoidal operation. The tumor was removed partially and the presumed CSF fistula was repaired. The sella and sphenoid sinus were packed with fat. BC treatment was reinstituted, and the serum PRL level decreased gradually without recurrent CSF rhinorrhea. Two weeks later the patient returned complaining of bilateral hearing disturbance. With a diagnosis of exudative otitis media she underwent bilateral tympanostomy. Immediately after tympanostomy, pulsating discharge from the middle ear was observed.(ABSTRACT TRUNCATED AT 250 WORDS)